中国血液净化

›› 2010, Vol. 9 ›› Issue (8): 418-422.doi: 10.3969/j.issn.1671-4091.2010.08.004

• 临床研究 • 上一篇    下一篇

腹膜透析辅助治疗重症狼疮性肾炎合并急性肾损伤的临床分析

周 岩 俞雨生 唐 政 刘志红 李世军 胡伟新 黎磊石   

  1. 南京军区南京总医院肾脏病科
  • 收稿日期:2010-05-13 修回日期:1900-01-01 出版日期:2010-08-12 发布日期:2010-08-12
  • 通讯作者: 俞雨生

Clinical analysis of peritoneal dialysis as an adjuvant therapy for severe lupus nephritis patients complicated with acute kidney injury

ZHOU Yan, YU Yu-sheng, TANG Zheng,   

  1. Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 21002, China
  • Received:2010-05-13 Revised:1900-01-01 Online:2010-08-12 Published:2010-08-12

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摘要： 【摘要】目的 观察腹膜透析对重型狼疮性肾炎(lupus nephritis,LN)合并重要脏器功能受损患者的临床疗效。方法 2003年11月至2008年6月间共8例确诊为重症LN合并多脏器功能受损患者行腹膜透析治疗，其中男性3例，女性5例，年龄18～54岁，全部患者符合以下特点：①因狼疮活动、肾功能进行性恶化，无法继续应用免疫抑制剂；②合并严重浮肿、心功能不全及严重的营养不良；③严重消化道症状。采用外科开放式手术置管，常规透析2000 ml/次，3～4次/d，待上述情况好转后及时给予免疫抑制剂治疗。所有患者随访时间均大于4个月。观察患者的肾功能变化情况、营养状况、系统性红斑狼疮活动指标、免疫抑制剂的应用情况。结果 ①临床疗效：8例重症LN患者一般情况明显改善，浮肿消退，心功能改善，精神、体力明显好转，其中5例肾功能恢复而摆脱透析，另3例肾功能亦有明显改善。②营养指标：所有患者的营养指标均有明显改善。③免疫学指标：在腹膜透析后继续使用强的松及其他免疫抑制剂(霉酚酸酯)共有5例自身抗体(抗核抗体、抗双链DNA抗体)滴度明显下降，2例无变化，1例抗核抗体滴度增高。系统性红斑狼疮疾病活动指数均明显降低。④并发症：共有1例发生腹膜炎。结论 重症LN合并重要脏器功能损害时可以及时腹膜透析。腹膜透析不仅可以改善患者的浮肿、心力衰竭、氮质血症等症状，对保护患者的残余肾功能、改善患者的营养状态有重要作用，同时在腹膜透析过程中需及时、合理应用免疫抑制剂进一步治疗原发病，从而可使LN患者的肾功能部分恢复。

关键词: 腹膜透析, 系统性红斑狼疮, 残余肾功能, 免疫抑制剂

Abstract: 【Abstract】Objective The purpose of this study was to evaluate the clinical efficacy of continuous ambulatory peritoneal dialysis (CAPD) for severe lupus nephritis (LN) patients complicated with important organ dysfunctions. Methods Eight patients diagnosed as severe LN complicated with multiple organ dysfunctions and undergoing CAPD from November 2003 to June 2008 were enrolled in this study. They were characterized by the following features: ①Methylprednisolone pulse therapy was required due to active lupus and progressive renal failure, but immunosuppressant could not be continuously applied due to high catabolism; ②Regular therapy failed due to severe edema, cardiac insufficiency and severe malnutrition; and ③Severe gastrointestinal symptoms. Catheterization surgery was carried out, and CAPD was conducted at 2,000ml/time and 3-4 times/day. Immunosuppressant was re-administered when the above features improved. Changes of renal function, nutrition status and systemic lupus erythematosus disease activity index (SLE-DAI), and the administration of immunosuppressant in these patients were followed up for at least 4 months. Results ①Clinical effects: Better general condition, regression of edema, and improvement of heart function, mental status and physical strength were found in the 8 patients. Renal function recovered significantly in all patients, and the CAPD discontinued in 5 of the 8 patients. ②Nutrition indices: Remarkable improvement was present in all patients. ③Immunological indices: In patients taking prednisone and other immunosuppressant therapy such as mycophenolate mofetil (MMF) after CAPD, ANA and anti-dsDNA antibody titers decreased significantly in 5 patients, and remained unchanged in 2 patients, and ANA titer increased in one patient. SLE-DAI decreased significantly after CAPD in all patients. ④Complications: Peritonitis occurred in one patient. Conclusion Peritoneal dialysis can be used in severe LN patients complicated with important organ dysfunctions. After peritoneal dialysis, edema, heart failure and azotemia improved, the residual renal function preserved, and the nutritional status ameliorated in these patients. When the patient’s condition improves, immunosuppressant should be resumed to treat the primary disease and to help recover the residual renal function.

Key words: Systemic lupus erythematosus, Residual renal function, Immunosuppressant

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